Patient Packet. Sleep/Wake Disorders Center Centers of Excellence
|
|
- Janice O’Connor’
- 7 years ago
- Views:
Transcription
1 Patient Packet Sleep/Wake Disorders Center Centers of Excellence
2 Sleep Center directions To help determine your medical treatment, your physician has requested that you undergo sleep testing at the Community Health Network Sleep/Wake Disorders Center located at: Community Hospital North Sleep/Wake Disorders Center 7250 Clearvista Dr., Suite 350 Indianapolis, IN The Sleep Center is located on the campus of Community Hospital North at 82nd Street, just off I-69 at Exit 1. Upon entering the 7250 building, take the elevator to the 3rd floor. Turn left and proceed to the end of the hallway. Turn left again and proceed to Suite 350. Please press the intercom button and a technician will assist you. If you need assistance from the Lobby to the Sleep Center, please call to make arrangements prior to your appointment. Wheelchairs are available in the Lobby. Community Hospital North Pediatric Sleep/Wake Disorders Center 7150 Clearvista Dr. Indianapolis, IN Located at 82nd Street, just off I-69 at Exit 1, the Sleep Center is located within Community Hospital North. Please enter through the main entrance and report to Outpatient Registration. Community Hospital East Sleep/Wake Disorders Center 1400 N. Ritter Avenue, Suite 481 Indianapolis, IN ZZZZ after 4:30 p.m. Community Hospital East is located on Ritter Avenue between 10th & 16th Streets. Community Health Pavilion Community South Sleep/Wake Disorders Center 333 E. County Line Road, Suite D Greenwood, IN ZZZ Take I-65 to the County Line Road Exit. Head West on County Line and cross Emerson Avenue. The Community Health Pavilion will be on the South side of the street, across from Smock Golf Course.
3 Map of locations Meridian Street Community Medical Pavilion Carmel 82nd Street Community Hospital North Greenfield Washington Street Capital Ave. 16th Street Community Hospital East Meridian Street Shelbyville Stop 11 County Line Road Community Hospital South Sleep/Wake Disorders Center Please pre-register prior to your test at ZZZZ. You may also pre-register online at ecommunity.com You have been scheduled for the following: Test Test date Arrival time End time Overnight study Daytime study CPAP/BIPAP adjustment Please do not arrive earlier than 8:30 p.m. for your appointment unless otherwise noted below. Other: If you have questions regarding insurance benefits for testing, please contact your insurance company regarding your personal coverage. If you cannot keep your appointment, please call For additional information regarding Sleep/Wake Disorders, visit us online at ecommunity.com/sleep
4 General information Go about your usual activities, but NO daytime naps. DO NOT drink alcoholic beverages the day of the study. DO NOT drink coffee, tea or soda with caffeine after 5 p.m. *Chocolate also contains caffeine. Please bathe and shampoo your hair before coming. DO NOT put any conditioners, hairspray or oils in your hair. Also, please do not put lotions on your body. Please have your evening meal before arriving for your sleep study. Please bring sleeping attire (pajamas, gown, etc., preferably not silk) and toiletries. You are welcome and encouraged to bring your own pillow to use during your stay. The sleep study will begin at approximately 11 p.m. At that time, no electronic devices can be used. These devices include but are not limited to: TVs, ipods, computers, or cell phones. A quiet, uninterrupted night is vital to the interpreting physician in making a diagnosis. For daytime tests, we suggest that you bring magazines, puzzles, crafts, etc., to keep busy between testing. Televisions and VCR/DVD players are in each room. If you are presently taking medications, do not bring them with you unless you MUST take them during your study. If so, bring ONLY that/those in dose(s) in their original containers. Over the counter medications are not available at the Sleep/Wake Disorders Center. Newly prescribed medications that affect your sleep (sleeping pills, tranquilizers, etc.) should not be started within one week of the sleep test. Breakfast and lunch are provided if you are staying for daytime testing. All rooms are private with restroom facilities. Please note that all sleep tests are considered outpatient procedures. Sleeping accommodations are not available for family members or guests. If a child is 17 years of age or younger, we do require that a parent or guardian stay with the child overnight. Smoking is NOT permitted in the hospital or on hospital grounds. What is a sleep study? A sleep study, also called a polysomnogram, measures the quality of a person s sleep. The study allows our sleep specialist to diagnose and treat many sleep disorders. The test does NOT hurt. It is painless and non-invasive and occurs in our state-of-the-art sleep laboratory. We use tape or sticky paste to place all electrodes on you. We do not use any needles or drugs. You will be snuggled in a beautiful, comfortable room similar to what you would find in an upscale hotel. Our equipment and monitors are located in a central control room so as not to alarm or disrupt your sleep. The data collected while you sleep includes: brain activity, muscle tone, heart rate, breathing movements and patterns, airflow and oxygen levels, and arm and leg movement. What to expect When you arrive at the Sleep Center, the technologist will apply several electrodes and sensors to your head and other parts of your body. This process will take approximately one hour, so you will not be able to go to bed as soon as you arrive. Television and radio are not permitted once the test has started. The test will last a minimum of six hours in bed. Often, additional testing is scheduled during the day following your overnight test. Please refer to Your Appointment page for your testing times. If no additional testing is scheduled, you will be allowed to leave. The results of your test will be analyzed by a neurologist or a pulmonologist. The results will be sent to the referring physician approximately two weeks after the study. You will receive a copy of your results via mail approximately four to six weeks after the study. Please note when you receive your billing for these tests, you will receive two statements. The hospital bill includes charges for technicians, equipment and supplies. The physician bill includes charges for the supervision and interpretation of the test results. Sleep studies can make a huge contribution to both your mental health and physical well-being.
5 Information on sleep/wake disorders Good sleep is important for good health. However, according to the National Sleep Foundation, 65 percent of Americans report that they do not get enough sleep (most adults need six to eight hours). Sleep disorders and lack of sleep are not just annoyances; they are serious problems. Those with sleep problems may think or move more slowly, make more mistakes or have memory difficulties. These negative effects can lead to poor job productivity and can be a contributing factor in motor vehicle accidents, weight gain, heart problems, colds and flu. Lack of sleep can also strain emotions, family and job relationships and social encounters, and lead to greater health problems if left untreated. Sleep apnea/snoring Sleep apnea is the cessation of breathing for a period of 10 seconds or more. It is characterized by snoring or choking/gasping for breath during sleep, daytime sleepiness and morning headaches. Recent studies indicate that there is a relationship between these sleep disorders and heart disease. Insomnia Insomnia is the inability to go to sleep or stay asleep. Restless leg syndrome (RLS) and periodic limb movement disorder (PLMD) RLS/PLMD is the movement or twitching of the legs during sleep that can sometimes awaken the individual. Narcolepsy/excessive daytime sleepiness Narcolepsy occurs when the brain doesn t accurately interpret when to sleep and when to be awake. Other sleep disorders While sleep apnea, periodic leg movements and continuous agonizing drowsiness account for 95 percent of all sleep disorders, others do exist. Among them are parasomnias/sleep walking and talking, bruxism/teeth grinding and poor sleep hygiene/sleep habits. Talk with your physician or a sleep professional if you are concerned about one of these disorders. General warning signs that may indicate a sleep disorder: Snoring Gasping or choking during sleep Memory loss Hypertension Excessive daytime sleepiness Restless sleep Poor judgment/concentration Irritability Morning headaches Obesity Congestive heart failure Attention deficit disorder Sexual dysfunction Of course not all sleep problems represent a sleep disorder, but poor quality of sleep can be related to many serious health risks and should be diagnosed and treated by a board-certified sleep physician.
6 Please complete this questionnaire and bring it with you to your appointment.
7 Please complete this questionnaire and bring it with you to your appointment. Community Health Network Sleep/Wake Disorders Center Sleep history questionnaire: Name: Date of Birth: Age: Height: Weight: Referring Doctor: Primary Care Doctor: Additional Doctors to send sleep/wake test results to: address: Medical History: What was your weight: 6 months ago 2 years ago High School Do you smoke? Yes h No h If so, how many packs per day? How many cups of coffee, or caffeinated soft drinks, do you drink on an average day? Do any of your immediate family members have a sleep disorder? Yes h No h If so, what kind? Month/Year of last hospitalization: / For what problem? Current medications: (Please list: name, strength, and how the medication is taken) List any food and medication allergies you have:
8 A few simple guidelines: The following questions will help us to better understand your sleep/wake behavior and problems, and more accurately interpret the results of your sleep/wake testing. It is important for you to answer each question as completely and accurately as you can. Some of the questions might be better answered by someone else (e.g. your spouse, roommate, partner, family member.) Please get their input as well. Do not spend too much time on any question. Your first impression is generally the most accurate. The time period referred to is the PRESENT, which includes the last 6 months, unless otherwise specified. A WEEKDAY is any day on which you ordinarily work. If you are engaged in shift work, or have any type of unusual sleep/wake schedule other than DAYTIME and NIGHTTIME, refer to your particular major sleeping and waking periods. All answers will be kept confidential. Occupation: Your present work schedule is best described as: Unemployed h Days h Evenings h Nights h Rotating h Your work shift starts at: a.m. Your work shift ends at: a.m. p.m. p.m. Your current sleep schedule: Week Days Week Ends What time do you usually go to bed? How long does it usually take for you to go to sleep? What time do you usually get up? Questions about your current sleep: How often do you: Never Sometimes Always sleep soundly? h h h have frequent brief awakenings? h h h have difficulty going to sleep? h h h wake up early in the morning and can t go back to sleep? h h h experience restless legs? h h h (crawling, aching sensation in legs relieved by movement) have periodic body movements during sleep? h h h
9 Never Sometimes Always have restless disturbed sleep? h h h disturb your partner s sleep because of snoring? h h h stop breathing in your sleep? h h h awaken from sleep due to choking? h h h awaken from sleep due to pain? h h h awaken from sleep to urinate? h h h walk in your sleep? h h h awaken screaming, violent or confused? h h h physically act out your own dreams? h h h feel anxious about inability to sleep? h h h have nightmares (frightening dreams)? h h h feel unable to move (paralyzed) for a few minutes upon awakening or going to sleep? h h h experience dream-like images (hallucinations) upon awakening even though you know that you are awake? h h h have insomnia? h h h have a headache upon awakening? h h h Do you have any other problems with your sleep? (please describe) Questions about your current ability to stay alert: How great of a problem do you have: Never Sometimes Always staying awake and alert during the day? h h h with attention and mental focus? h h h staying awake while inactive (e.g. reading)? h h h doing your job because of drowsiness? h h h driving because of drowsiness? h h h
10 During the past 6 months, how often have you had: Never Sometimes Always spontaneous episodes of unintentionally falling to sleep? h h h any near-accidents because of sleepiness? h h h Have you had any actual accidents due to sleepiness? Yes h No h How many? How often do you: Never Sometimes Always experience vivid dreams during naps? h h h perform a complex act such as driving a car to the wrong destination and not remember how you did it? h h h have a sudden feeling of weakness come over you when you laugh, are angry or excited? h h h feel weak knees when you laugh? h h h What is your personal interpretation as to why you have your particular sleep/wake problem? Epworth Sleepiness Scale: How likely are you to doze off or fall asleep in the following situations in contrast to feeling just tired? This refers to your usual way of life in recent times. Even if you have not done some of these things recently, try to decide how they would have affected you. Use the following scale to choose the most appropriate number for each situation: 0 = no chance of dozing 1 = slight chance of dozing 2 = moderate chance of dozing 3 = high chance of dozing SITUATION Sitting and reading Watching TV Sitting inactive in a public place (e.g. a theater or a meeting) As a passenger in a car for an hour without a break Lying down to rest in the afternoon when circumstances permit Sitting and talking to someone Sitting quietly after a lunch without alcohol In a car, while stopped for a few minutes in traffic Total: CHANCE OF DOZING
11 Homecare Company Referrals: In the event that you should require the service of a homecare company, we will refer you to Community Home Health Services. If they are not a provider covered by your insurance, another selection will be necessary for insurance approval. If you have a personal preference for a homecare company, please list below. Preferred Homecare Company: Consent for Video Taping: I, the undersigned, have been informed of the photographic procedure and hereby grant permission to the Community Health Network and/or, M.D. to use the video for diagnosing sleep related problems. I realize that I may withdraw my consent at any time and that this action will not prejudice or jeopardize the care I receive in any way. I have been given an explanation for the purpose and intended use of the resulting videotape and the approximate amount of time required for taping. I have had described to me the methods used to insure confidentiality. Your sleep study will start as close to 11:00 p.m. as possible. Once your study has started, no electronic devices can be used. These devices include, but are not limited to: TV, IPod, Computer, or Cell Phone. A quiet, uninterrupted night is vital to aid your physician in making a diagnosis. Thank you for understanding. I understand that most insurance companies require at least 6 hours of time in bed to justify payment for a sleep test. Furthermore, I understand my voluntary termination of the sleep test before 6 hours may result in my insurance company s denial of payment. I have read all information provided to me and have answered all questions as accurately as possible. I hereby give my consent to proceed with testing. Signature (Individual of legal age or parent/guardian or legally authorized representative) Date Witness (Name and Credential) Date Time
Why are you being seen at Frontier Diagnostic Sleep Center?
8425 South 84th Street Suite B Omaha, NE 68127 Phone: 402.339.7378 Fax: 402.339.9455 SLEEP QUESTIONNAIRE NAME: ADDRESS: Last First MI Street Address DATE City State Zip PHONE: ( ) BIRTHDATE: HEIGHT: WEIGHT:
More informationSleep Disorders Center 505-820-5363 455 St. Michael s Dr. 505-989-6409 fax Santa Fe, New Mexico 87505 QUESTIONNAIRE NAME: DOB: REFERRING PHYSICIAN:
Sleep Disorders Center 505-820-5363 455 St. Michael s Dr. 505-989-6409 fax Santa Fe, New Mexico 87505 QUESTIONNAIRE NAME: DOB: REFERRING PHYSICIAN: PRIMARY CARE PHYSICIAN: Do you now have or have you had:
More informationSleep History Questionnaire
Sleep History Questionnaire Name Address Daytime Phone Height Evening Phone Weight Weight 5yrs ago Describe your sleep problem: 1. What time do you go to bed? 2. What time do you wake up? 3. What time
More informationSLEEP QUESTIONNAIRE. Name: Today s Date: Age (years): Your Sex (M or F): Height: Weight: Collar/Neck Size (inches) Medications you are taking:
SLEEP QUESTIONNAIRE Name: Today s Date: Age (years): Your Sex (M or F): Height: Weight: Collar/Neck Size (inches) Medications you are taking: Medical conditions: High blood pressure Heart Disease Diabetes
More informationbuilding. 2. Enter Turn the on 5305 and begin Building testing and take the elevator/stairs to the third floor, turn right and go into
SLEEP DISORDERS CENTER St. Joseph Mercy Ann Arbor 5305 Elliott Drive, Ypsilanti, MI 48197 734-712-2276 / Fax 734-712-2967 Sleep Study Information Home Sleep Apnea Testing Dear,, Your are Sleep scheduled
More informationFull name: Male Female
6700 W. Ninth Ave. Amarillo, TX 79106 Phone (806) 356-5522 www.adcsleepdisorders.com THE EPWORTH SLEEPINESS SCALE Full name: Male Female Date: Age: How likely are you to doze off or fall asleep in the
More informationSLEEP QUESTIONNAIRE THE EPWORTH SLEEPINESS SCALE
SLEEP QUESTIONNAIRE Patient Name: Height: Weight: Date : My Main Sleep Complaint(s) : Trouble sleeping at night.. yes no Falling asleep.. yes no Staying asleep.. yes no Snoring. yes no Stop breathing yes
More informationMemorial Hospital Sleep Center. Rock Springs, Wyoming 82901. Sleep lab Phone: 307-352- 8229 (Mon - Wed 5:00 pm 7:00 am)
Memorial Hospital Sleep Center Rock Springs, Wyoming 82901 Sleep lab Phone: 307-352- 8229 (Mon - Wed 5:00 pm 7:00 am) Office Phone: 307-352- 8390 (Mon Fri 8:00 am 4:00 pm ) Patient Name: Sex Age Date Occupation:
More informationPreparation guidelines for your Child s Sleep Study
Preparation guidelines for your Child s Sleep Study Patient Sticker here Maintain your child s regular night sleeping and nap schedule for several days before the study. On the day of the study, do not
More informationDon t just dream of higher-quality sleep. How health care should be
Don t just dream of higher-quality sleep. How health care should be Many of our patients with sleep disorders don t realize there s another way of life, a better way, until they are treated. Robert Israel,
More informationSLEEP DISORDER ADULT QUESTIONNAIRE
SLEEP DISORDER ADULT QUESTIONNAIRE Name: Date: Date of Birth (month/day/year): / / Gender: ο Male ο Female Marital Status: ο Never Married ο Married ο Divorced ο Widowed Home Address: City: Zip: Daytime
More informationPlease have your bed partner assist you with the enclosed questionnaire and bring it, completed, with you to your scheduled sleep appointment.
Welcome! Please read the following document carefully as it contains pertinent information regarding your sleep study, interpretation of your study, and billing information. On behalf of our staff here
More informationGeneral Information about Sleep Studies and What to Expect
General Information about Sleep Studies and What to Expect Why do I need a sleep study? Your doctor has ordered a sleep study because your doctor is concerned you may have a sleep disorder that is impacting
More informationSLEEP QUESTIONNAIRE AND WAKEFULNESS
SLEEP QUESTIONNAIRE AND WAKEFULNESS (SQAW) PATIENT: DOCTOR: DATE COMPLETED: Must Be Completed by Appointment Date 7423-029-W-BKLT 11-1-09 For questions to be answered on a scale of 1 to 5, please circle
More informationMarshall Sleep Disorders Center PATIENT INFORMATION FORM (PLEASE PRINT) DATE: Date of Birth: Age: Sex: M F. Home Phone: ( ) Work Phone: ( )
Marshall Sleep Disorders Center PATIENT INFORMATION FORM (PLEASE PRINT) DATE: Name: Last First MI SSN# Address: Street City State zipcode Date of Birth: Age: Sex: M F Height: Weight: Home Phone: ( ) Work
More informationSleep Difficulties. Insomnia. By Thomas Freedom, MD and Johan Samanta, MD
Sleep Difficulties By Thomas Freedom, MD and Johan Samanta, MD For most people, night is a time of rest and renewal; however, for many people with Parkinson s disease nighttime is a struggle to get the
More informationTHE CENTER FOR SLEEP DISORDERS GW- MEDICAL FACULTY ASSOCIATES SLEEP DISORDERS INVENTORY
THE CENTER FOR SLEEP DISORDERS GW- MEDICAL FACULTY ASSOCIATES SLEEP DISORDERS INVENTORY Vivek Jain, M.D. Director, The Center for Sleep Disorders GW-Medical Faculty Associates Samuel J. Potolicchio, M.
More informationPatient Sleep Questionnaire
Patient Sleep Questionnaire Patient Name: _ Sex: Age: Date: Occupation: _ Usual Work Hours/Days: _ Referring Physician: Family Physician (PCP): Patient s email address: Please complete the following questionnaire
More informationSLEEP AND PARKINSON S DISEASE
A Practical Guide on SLEEP AND PARKINSON S DISEASE MICHAELJFOX.ORG Introduction Many people with Parkinson s disease (PD) have trouble falling asleep or staying asleep at night. Some sleep problems are
More informationInstructions for In-Lab Sleep Study Procedures
Instructions for In-Lab Sleep Study Procedures Please refer to the font of this booklet or email for the test you have been scheduled for Description Procedure Code Standard PSG (Polysomnogram) 95810 Split
More informationInsomnia affects 1 in 3 adults every year in the U.S. and Canada.
Insomnia What is insomnia? Having insomnia means you often have trouble falling or staying asleep or going back to sleep if you awaken. Insomnia can be either a short-term or a long-term problem. Insomnia
More informationName,, Last First MI DOB Age Current Occupation. Home Phone Work phone Cell Phone
Date / / Name,, Last First MI DOB Age Current Occupation Home Phone Work phone Cell Phone Ethnicity : White Hispanic Asian African American American Indian Pacific Islander Other What is your primary language?
More informationF Be irritable F Have memory problems or be forgetful F Feel depressed F Have more falls or accidents F Feel very sleepy during the day
National Institute on Aging A Good Night s Sleep Ever since he retired, Edward dreads going to bed at night. He s afraid that when he turns off his light, he will just lie there with his eyes open and
More informationSleep and Brain Injury
Patient Education Sleep and Brain Injury This handout describes how brain injury may affect sleep. A list of resources is included. Why is sleep important? During sleep, your brain and body recharge. Proper
More informationHow To Avoid Drowsy Driving
How To Avoid Drowsy Driving AAA Foundation for Traffic Safety Sleepiness and Driving Don t Mix Feeling sleepy is especially dangerous when you are driving. Sleepiness slows your reaction time, decreases
More informationelf-awareness Toolkit
S Snoring & Sleep Apnea elf-awareness Toolkit Snoring: Your Dentist Can Test So You Can Rest 2009 Snoring Isn t Sexy, LLC S Snoring & Sleep Apnea elf-awareness Toolkit Snoring: Your Dentist Can Test So
More informationSUMMA HEALTH SYSTEM. Sleep Medicine Services
SUMMA HEALTH SYSTEM Sleep Medicine Services Contents Why should I be concerned about a sleep disorder? 2 Evaluate Your Daytime Sleepiness 3 Common sleep disorders 5 About sleep studies 6 What to expect
More informationAllergies to Medications: Yes ( ) No ( ) if yes, explain: Allergies to environmental agents: Yes ( ) No ( ) if yes, explain:
Accredited by the American Academy of Sleep Medicine Sleep History Questionnaire Name: Ht: Wt: Neck Size: Allergies to Medications: Yes ( ) No ( ) if yes, explain: Allergies to environmental agents: Yes
More informationUnderstanding Sleep Apnea
Understanding Sleep Apnea www.sleepmangementsolutions.com What is Obstructive Sleep Apnea (OSA)? OSA afflicts 20 million adult men and women in the U.S. People who have OSA stop breathing repeatedly during
More informationHaving a home sleep study? Rest easy. This booklet is designed to answer common questions you may have concerning your upcoming sleep study.
Having a home sleep study? Rest easy. This booklet is designed to answer common questions you may have concerning your upcoming sleep study. Your appointment is on: Your doctor suspects you may have a
More informationteenagers drowsy driving Staying safe behind the wheel a wellness booklet from the American Academy of Sleep Medicine
teenagers drowsy driving Staying safe behind the wheel a wellness booklet from the American Academy of Sleep Medicine Dear Reader Sleep isn t just time out from daily life. It is an active state important
More informationSleep Study Frequently Asked Questions
Sleep Study Frequently Asked Questions Upstate Sleep Center Medical Center West Suite 101 5700 West Genesee Street Camillus, NY 13031 (315) 487-5337 What Causes Snoring? Snoring is the sound made by air
More informationQuick Read Series. Information for people with seizure disorders
Quick Read Series Information for people with seizure disorders 2003 Epilepsy Foundation of America, Inc. This pamphlet is designed to provide general information about epilepsy to the public. It does
More informationSLEEP CENTER OF GREATER PITTSBURGH Scheduling Department Phone 724-274-8484 Fax 724-274-0378
Dear: SLEEP CENTER OF GREATER PITTSBURGH Scheduling Department Phone 724-274-8484 Fax 724-274-0378 This letter is to confirm your appointment for a sleep study on in our location. at Please look on the
More informationSleep Strategies Introduction: 1. Providing a comfortable sleep setting
Sleep Strategies Introduction: Sleep problems-- either trouble falling asleep, staying asleep, or early morning waking, are common problems in typically developing children and in children with Autism
More informationINSOMNIA SELF-CARE GUIDE
INSOMNIA SELF-CARE GUIDE University of California, Berkeley 2222 Bancroft Way Berkeley, CA 94720 Appointments 510/642-2000 Online Appointment www.uhs.berkeley.edu All of us have trouble sleeping from time
More informationWhat you Need to Know about Sleep Apnea and Surgery
What you Need to Know about Sleep Apnea and Surgery UHN For patients with sleep apnea who are going to have surgery Read this brochure to learn: What sleep apnea is Risks of having sleep apnea when going
More informationPatient Registration/ Information Sheet
Patient Registration/ Information Sheet Name: Last First Middle Date of Birth: Gender: F M Marital Status: Social Security Number: Street Address: City: State: Zip: Home Phone: Work Phone: Cell Phone:
More informationDr Sarah Blunden s Adolescent Sleep Facts Sheet
Dr Sarah Blunden s Adolescent Sleep Facts Sheet I am Sleep Researcher and a Psychologist. As a Sleep Researcher, I investigate the effects of poor sleep on young children and adolescents. I also diagnose
More informationSleep. Drug and Alcohol Services South Australia. Progressive stages of the sleep cycle. Understanding the normal sleep pattern
Drug and Alcohol Services South Australia INSOMNIA MANAGEMENT KIT Sleep: Facts and hygiene The Insomnia Management Kit is intended to be used in conjunction with your GP. To access further instructions
More informationSLEEP DIFFICULTIES AND PARKINSON S DISEASE Julie H. Carter, R.N., M.S., A.N.P.
SLEEP DIFFICULTIES AND PARKINSON S DISEASE Julie H. Carter, R.N., M.S., A.N.P. Problems with sleep are common in Parkinson s disease. They can sometimes interfere with quality of life. It is helpful to
More informationSTRESS INDICATORS QUESTIONNAIRE
The Counseling Team International 1881 Business Center Drive, Suite 11 San Bernardino, CA 92408 (909) 884-0133 www.thecounselingteam.com STRESS INDICATORS QUESTIONNAIRE This questionnaire will show how
More informationA Healthy Life RETT SYNDROME AND SLEEP. Exercise. Sleep. Diet 1. WHY SLEEP? 4. ARE SLEEP PROBLEMS A COMMON PARENT COMPLAINT?
Diet Sleep Exercise RETT SYNDROME AND SLEEP DR. DANIEL GLAZE, MEDICAL DIRECTOR THE BLUE BIRD CIRCLE RETT CENTER A good night s sleep promotes learning, improved mood, general good health, and a better
More informationPAIN MANAGEMENT. Patient s name: IF YOUR INSURANCE REQUIRES A PRE AUTHORIZATION / REFERRAL FORM, PLEASE OBTAIN PRIOR TO YOUR VISIT.
PAIN MANAGEMENT Please fill out the following questionnaire and bring it with you to your appointment. In addition, bring your medication list and Reports of any X- rays, MRI or Cat scans. Patient s name:
More informationHow to sleep better at night - sleep hygiene. Information for anyone having trouble sleeping
How to sleep better at night - sleep hygiene Information for anyone having trouble sleeping www.leicspart.nhs.uk mail: feedback@leicspart.nhs.uk Aim for a good night s sleep A good night s sleep should
More informationsleep handbook Keep this by your bedside to help you get straight to sleep.
sleep handbook Keep this by your bedside to help you get straight to sleep. BEDSIDE BUDDY Chiropractic how can it help me get straight to sleep? Chiropractic is based on the scientific fact that the human
More informationSLEEP RIGHT SLEEP TIGHT
SLEEP RIGHT SLEEP TIGHT Natural sleep before medicines Sleep diary What is a sleep diary? A sleep diary is a daily log that can be used to record your sleep-wake pattern. It helps you monitor when you
More informationPacific Sleep Program
Name: Date of Birth: / / Pacific Sleep Program Portland & Astoria Setting the standard in sleep medicine for over 30 years PATIENT QUESTIONNAIRE Hello, You have been referred to the Pacific Sleep Program
More informationSAMPLE. edin-labovernight ev. eatment sensorsbr. Your In-lab. ingsovernighthabits. sevaluationovernig. sks relaxedsenso. dybreathing technolo
Your In-lab sleep study sevaluationovernig rsleep recordingsh stsstudycomforta orsbrainwavesre nheartbeatspecialistslee dybreathing technolo sks relaxedsenso ingsovernighthabits eatment sensorsbr comfortablesleep
More informationMODULE MULTIPLE SLEEP LATENCY TEST (MSLT) AND MAINTENANCE OF WAKEFULNESS TEST (MWT)
MODULE MULTIPLE SLEEP LATENCY TEST AND MAINTENANCE OF WAKEFULNESS TEST (MWT) MULTIPLE SLEEP LATENCY TEST AND MAINTENANCE OF WAKEFULNESS TEST (MWT) OBJECTIVES: At the end of this module the student must
More informationSeizures explained. Helpline: 0808 800 2200 Text: 07786 209 501 www.epilepsyscotland.org.uk. Epilepsy Scotland Guides
Epilepsy Scotland Guides Seizures explained Helpline: 0808 800 2200 Text: 07786 209 501 www.epilepsyscotland.org.uk Epilepsy Scotland, 48 Govan Rd, Glasgow G51 1JL General: 0141 427 4911 Fax: 0141 419
More informationNEW PATIENT CLINICAL INFORMATION FORM. Booth Gardner Parkinson s Care & Movement Disorders Center Evergreen Neuroscience Institute
NEW PATIENT CLINICAL INFORMATION FORM Booth Gardner Parkinson s Care & Movement Disorders Center Evergreen Neuroscience Institute Date: Name: Referring Doctor: How did you hear about us? NWPF Your Physician:
More informationYoung Person s Guide to CFS/ME
Young Person s Guide to CFS/ME The Royal College of Paediatrics and Child Health This leaflet has been developed as part of the Evidence based guideline for management of CFS/ME (Chronic Fatigue Syndrome
More informationBCN e-referral Questionnaire Preview: Sleep study, outpatient facility or clinic-based setting
Sleep studies, outpatient facility or clinic-based setting Blue Care Network provides coverage for attended sleep studies in the outpatient treatment setting for pediatric members and for adult members
More informationDisordered sleep at night has long been
Neurology 59 Excessive daytime sleepiness in PD Excessive Daytime Sleepiness (EDS) in Parkinson s disease (PD) is an important issue that warrants serious attention because it can have adverse effects
More informationBBC LEARNING ENGLISH 6 Minute English Is modern life making us tired?
BBC LEARNING ENGLISH 6 Minute English Is modern life making us tired? NB: This is not a word-for-word transcript Hello and welcome to 6 Minute English. I'm and I'm. So, did you sleep well last night? Um,
More informationHEALTH RISK ASSESSMENT (HRS) QUESTIONNAIRE
HEALTH RISK ASSESSMENT (HRS) QUESTIONNAIRE The Health Risk Assessment (HRA) questionnaire provides participants with an evaluation of their current health and quality of life. The assessment promotes health
More informationIMPORTANCE OF SLEEP. Essential to your physical health and emotional wellbeing. Helps improve concentration and memory formation
IMPORTANCE OF SLEEP Essential to your physical health and emotional wellbeing Helps improve concentration and memory formation Allows your body to repair any cell damage that occurred during the day Refreshes
More informationUnderwriting Sleep Apnea
Underwriting Sleep Apnea Joel Weiner, MD, FLMI April 29, 2014 WAHLU The Northwestern Mutual Life Insurance Company Milwaukee, WI A Brief Survey Before We Get Started The Weiner Sleepiness Scale How likely
More informationSLEEP CLINIC Patient Information Sheet
SLEEP CLINIC Patient Information Sheet It is very important that you arrive for your scheduled appointment. If you are unable to make it to your appointment, please ensure you call the clinic to cancel
More informationFalling Asleep & Staying Asleep Handout
Falling Asleep & Staying Asleep Handout This handout contains information that may help if you have difficulty falling asleep or staying asleep. In the pages that follow, you will learn about sleep disorders
More informationSLEEP DISORDERS CENTER SLEEP CLINIC PATIENT QUESTIONNAIRE. Please bring this completed questionnaire with you to your sleep clinic appointment.
SLEEP DISORDERS CENTER Please bring this completed questionnaire with you to your sleep clinic appointment. Patient s Name: Date: Referring Physician: Clinic Location: 1. Why are you being seen in the
More informationSLEEP DISTURBANCE AND PSYCHIATRIC DISORDERS
E-Resource December, 2013 SLEEP DISTURBANCE AND PSYCHIATRIC DISORDERS Between 10-18% of adults in the general population and up to 50% of adults in the primary care setting have difficulty sleeping. Sleep
More informationElectroconvulsive Therapy (ECT)
Electroconvulsive Therapy (ECT) What is ECT? Electroconvulsive therapy (ECT) is a physical therapy in which a patient under general anesthetic will have an electrical current passed through his or her
More informationReading: Skimming and Scanning
Reading: Skimming and Scanning Skimming involves quickly glancing through a text to get a general sense of what it is about. You do not actually read the whole piece; you simply look through it, perhaps
More informationBuilding a. With Your Doctor
Building a With Your Doctor As a mental health consumer, there are many things you can do to improve your care and get more out of life. Learning more about your illness, current treatment options and
More informationSLEEP APNEA SCREENING AND SURVEILLANCE Low Cost Monitoring Device
SLEEP APNEA SCREENING AND SURVEILLANCE Low Cost Monitoring Device Sammy Homsi and Mustafa Muhyi Team Number: 42 Teacher: Rebecca Galves Mentor: Noor Muhyi CONTENTS Figure and tables...2 Abstract 3 Introduction..
More informationCity: State: Zip: City: State: Zip: Phone: Birth Date: Age: Marital Status: Single Married Divorced Widowed Cell Phone: City: State: Zip:
Name: Mailing Address: First M.I. Last Today s Date: Physical Address: Phone: Birth Date: Age: Marital Status: Single Married Divorced Widowed Cell Phone: Employer: Occupation: Employer s Address: Work
More informationRestless Legs Syndrome Creepy-Crawly Legs Causing Distress?
written by Harvard Medical School Restless Legs Syndrome Creepy-Crawly Legs Causing Distress? www.patientedu.org Although many of us take it for granted, sleep is very important for health. For some 12
More informationUrinary Incontinence. Patient Information Sheet
Urinary Incontinence Patient Information Sheet What is urinary incontinence (UI)? UI happens when you are not able to control when you urinate and you wet yourself. How common is urinary incontinence?
More informationSUMMARY OF FINDINGS. National Sleep Foundation 2005. National Sleep Foundation
SUMMARY OF FINDINGS National Sleep Foundation 2005 National Sleep Foundation 1522 K Street NW, Suite 500 Washington, DC 20005 Ph: (202) 347-3471 Fax: (202) 347-3472 www.sleepfoundation.org Prepared by:
More informationPatient Questionnaire for Men
Patient Questionnaire for Men Please fill out the following questionnaire to the best of your ability prior to your first appointment. Your physical therapist will review your responses during your initial
More informationNursing Interventions for Sleep Disorders Following TBI
Nursing Interventions for Sleep Disorders Following TBI Kadesha Clark, RN BSN When you sleep, your body rests and restores its energy levels. A good night's sleep is often the best way to help you cope
More informationCONCORD INTERNAL MEDICINE TESTOSTERONE DEFICIENCY PROTOCOL
CONCORD INTERNAL MEDICINE TESTOSTERONE DEFICIENCY PROTOCOL Douglas G. Kelling, Jr., MD Carmella Gismondi-Eagan, MD, FACP George C. Monroe, III, MD Revised April 29, 2012 The information contained in this
More informationIntake Form for Testing Services. Last Name First Name Date of Birth. Address City State/ZIP Sex (M/F)
Intake Form for Testing Services Date Last Name First Name Date of Birth Address City State/ZIP Sex (M/F) Email Address: @ CAN I EMAIL YOU FOR: (CIRCLE ALL THAT APPLY) SCHEDULING SERVICES UPDATES AVAILABLE
More informationCorporate Medical Policy
Corporate Medical Policy Polysomnography for Non Respiratory Sleep Disorders File Name: Origination: Last CAP Review: Next CAP Review: Last Review: polysomnography_for_non_respiratory_sleep_disorders 10/2015
More informationCPAP (Continuous Positive Airway Pressure) Titration Study
Helene A. Emsellem, MD Medical Director John R. Ruddy, MD Linda Croom, ANPC Karen Murtagh, CRNP Richard Currey, PA-C CPAP (Continuous Positive Airway Pressure) Titration Study About the CPAP Titration
More informationThe Older And Wiser Driver
The Older And Wiser Driver AAA Foundation for Traffic Safety Sharpening Your Driving Skills Aging is inevitable, but growing older doesn t have to mean giving up an active life. While aging does impose
More informationPERSONAL COACHING AGREEMENT
PERSONAL COACHING AGREEMENT Full Name:_ Nickname (if any): Mailing Address: Work Phone: Cell Phone: Home Phone: Fax: E-Mail Address:_ Website(s):_ Date of Birth: Marital Status: Significant Other's Name:
More informationSleep Apnea Dr. Douglas Tapper
Sleep Apnea Dr. Douglas Tapper Dr. Hendler: Hello and welcome to KP Healthcast. I m your host today, Dr. Peter Hendler, and our guest is Dr. Douglas Tapper who is the chief of Pulmonary Medicine at Kaiser
More informationAbout the Monitoring Units
epilepsy center About the Monitoring Units clevelandclinic.org/epilepsycenter Cleveland Clinic Epilepsy Center The Cleveland Clinic Epilepsy Center, established in 1978, is a national and international
More informationSleep Issues and Requirements
How Much Sleep Do I Need? Sleep Issues and Requirements http://kidshealth.org/pagemanager.jsp?dn=kidshealth&lic=1&ps=207&cat_id=20116&article_set=20280 TeensHealth.org: A safe, private place to get doctor-approved
More informationAbout Sleep Apnea ABOUT SLEEP APNEA
ABOUT SLEEP APNEA About Sleep Apnea What is Sleep Apnea? Sleep Apnea (from Greek, meaning "without breath") is one of the most common sleep disorders in which breathing stops and then restarts again recurrently
More informationMultiple System Atrophy guide (http://www.msaweb.co.uk/msaguide.htm)
Multiple System Atrophy guide (http://www.msaweb.co.uk/msaguide.htm) Accessing information on Multiple System Atrophy (MSA) can be hard work. The Sarah Matheson Trust (SMT) produces a guide to MSA that
More informationInsomnia. Student Counselling Service 20 Laurie Grove T 020 7919 7472 mcs01cs@gold.ac.uk
Insomnia Student Counselling Service 20 Laurie Grove T 020 7919 7472 mcs01cs@gold.ac.uk Goldsmiths, University of London New Cross London SE14 6NW T 020 7919 7774 F 020 7919 7773 www.goldsmiths.ac.uk Insomnia
More information1. All of your medications.
993 C Johnson Ferry Road, Suite 300 Atlanta, GA 30342 404-303-1700 or 404-250-4530 Fax 404-252-8026 To Our New Patients: On behalf of the North Atlanta Pulmonary & Sleep Specialists (NAPS), we welcome
More informationRECOGNISE AND REMOVE
RECOGNISE AND REMOVE Remember the 4 R s of concussion management: RECOGNISE REMOVE RECOVER RETURN Identifying concussion is not always easy, and players may not exhibit the signs or symptoms immediately
More informationAbout Our Monitoring Units
epilepsy center About Our Monitoring Units clevelandclinic.org/epilepsycenter Cleveland Clinic Epilepsy Center Our Epilepsy Center, established in 1978, is a national and international pacesetter in the
More informationSupplementary Online Content
Supplementary Online Content Tannenbaum C, Martin P, Tamblyn R, Benedetti A, Ahmed S. Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER
More informationNeurological causes of excessive daytime sleepiness. Professor Adam Zeman Royal Devon and Exeter Hospital University of Exeter Medical School
Neurological causes of excessive daytime sleepiness Professor Adam Zeman Royal Devon and Exeter Hospital University of Exeter Medical School Excessive daytime sleepiness Physiological sleep deprivation,
More informationMedical Information to Support the Decisions of TUECs INTRINSIC SLEEP DISORDERS
Introduction Excessive daytime sleepiness (EDS) is a common complaint. Causes of EDS are numerous and include: o Intrinsic sleep disorders (e.g. narcolepsy, obstructive sleep apnoea/hypopnea syndrome (OSAHS)
More informationEpilepsy and stress / anxiety
Epilepsy and stress / anxiety Stress is a term used to describe emotional strain and tension. When we experience stress we also can become anxious. Although stress and anxiety do not cause epilepsy, for
More informationMVA/ PI Registration Form. Is this accident work related? YES or No If yes, stop here and notify front desk for different forms.
MVA/ PI Registration Form Is this accident work related? YES or No If yes, stop here and notify front desk for different forms. Date: Patient # Patient Name: DOB; Gender: M or F SSN Address: City/State:
More informationDiagnosis and Treatment
Sleep Apnea: Diagnosis and Treatment Sleep Apnea Sleep Apnea is Common Dangerous Easily recognized Treatable Types of Sleep Disordered Breathing Apnea Cessation of airflow > 10 seconds Hypopnea Decreased
More informationCh 7 Altered States of Consciousness
Ch 7 Altered States of Consciousness Consciousness a state of awareness Altered State of Consciousness involves a change in mental processes in which one is not completely aware Sleep is a state of altered
More informationINF159. Tiredness can kill. Advice for drivers. including drivers with Obstructive Sleep Apnoea Syndrome (OSAS) 2/16
INF159 Tiredness can kill Advice for drivers including drivers with Obstructive Sleep Apnoea Syndrome (OSAS) 2/16 What if I have a condition causing sleepiness/tiredness during the day? You need to tell
More informationAlzheimer s disease. Reducing caregiver stress
Alzheimer s disease Reducing caregiver stress Supporting a person with Alzheimer s disease requires time and energy. While it can be a rewarding experience, it can also be demanding and stressful. Knowing
More informationElectroconvulsive Therapy ECT and Your Mental Health
Electroconvulsive Therapy ECT and Your Mental Health Mental Health and Addictions Program St. Joseph s Healthcare Hamilton Charlton Campus 50 Charlton Avenue East Hamilton, Ontario 905-522-1155 ext. 33684
More informationLewy body dementia Referral for a Diagnosis
THE Lewy Body society The more people who know, the fewer people who suffer Lewy body dementia Referral for a Diagnosis Lewy Body Dementias REFERRAL FOR A DIAGNOSIS In the UK people with all forms of dementia
More informationManage cancer related fatigue:
Manage cancer related fatigue: For People Affected by Cancer In this pamphlet: What can I do to manage fatigue? What is cancer related fatigue? What causes cancer related fatigue? How can my health care
More information